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Mohammadi F, Masoumi SZ, Oshvandi K, Sobhan MR, Bijani M. Parents' perception of challenges of caring of children with Epidermolysis bullosa: a qualitative study. BMC Res Notes 2024; 17:302. [PMID: 39390602 PMCID: PMC11468270 DOI: 10.1186/s13104-024-06968-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2024] [Accepted: 10/04/2024] [Indexed: 10/12/2024] Open
Abstract
OBJECTIVE The present study was investigate parents' experiences of children with Epidermolysis bullosa. So, this descriptive phenomenological qualitative study was conducted on 17 parents of children with EB from five hospitals affiliated with the University of Medical Sciences, west of Iran. Data was collected through semi-structured interviews. COLAIZZI's method was also used to analyze the data. RESULTS Three main themes were extracted in this study: invasion of psychological crisis, alive but no living, and comprehensive support, including 10 categories. The parents of these children are the target of psychological crises that severely reduce their quality of life. In this regard, they need extensive support to improve their living conditions. Therefore, it is suggested to provide cultural and institutional contexts in which all components of the children's dignity are emphasized.
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Affiliation(s)
- Fateme Mohammadi
- Department of Pediatric Nursing, School of Nursing and Midwifery, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Seyedeh Zahra Masoumi
- Department of Midwifery, School of Nursing and Midwifery, Mother and Child Care Research Center Health Sciences & Technology Research Institute, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Khodayar Oshvandi
- Mother and Child Care Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Mohammad Raza Sobhan
- Department of Dermatology, School of Medicine, Sina (Farshchian) Educational and Medical Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Mostafa Bijani
- Department of Medical Surgical Nursing, Fasa University of Medical Sciences, Fahmideh Blv, fasa, Fasa, 81936-13119, Iran.
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Martínez-Ripoll JM, García-Domingo M, de la Fuente Robles YM. Epidermolysis Bullosa in Spain: A Qualitative Analysis of Its Social Impact on Families With Diagnosed Minors. Health Expect 2024; 27:e14128. [PMID: 38943541 PMCID: PMC11214136 DOI: 10.1111/hex.14128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2024] [Revised: 06/12/2024] [Accepted: 06/18/2024] [Indexed: 07/01/2024] Open
Abstract
BACKGROUND Epidermolysis bullosa (EB) comprises a group of rare types of genodermatoses characterized by extreme mucocutaneous fragility, leading to blistering and/or erosions, even with minimal trauma. Continuous care through wound management is an integral part of daily life for the families and individuals affected. The aim of this study was to assess the social reality and impacts on families of having minor members diagnosed with EB in Spain. METHODS A qualitative methodology was employed, utilizing four focus groups entailing participation by 24 parents (19 mothers and five fathers) of minors diagnosed with EB in Spain. RESULTS Negative impacts on the family nucleus were evident in four priority areas of analysis: sociorelational, economic-labour, physical and psychoemotional, with significant differences observed based on the severity of the symptoms. CONCLUSION Impacts on the family nucleus are noticeable from birth, influencing all other daily life routines and complicating family planning and organization. There is an imperative need to enhance the availability of sociohealth resources and to adopt an interdisciplinary approach to address their biopsychosocial needs. PATIENT OR PUBLIC CONTRIBUTION The active participation of relatives of minors diagnosed with Epidermolysis Bullosa (EB) is invaluable to sociohealth professionals, legislators and researchers. A team member conducts their professional activities at DEBRA España (national patient association dedicated to enhancing the quality of life for individuals with EB and their families), actively engaging in all study phases.
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Affiliation(s)
| | - Marta García-Domingo
- Department of Psychology, Faculty of Social Work, University of Jaén, Jaén, España
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Perceived Benefits and Facilitators and Barriers to Providing Psychosocial Interventions for Informal Caregivers of People with Rare Diseases: A Scoping Review. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2021; 13:471-519. [PMID: 32785886 DOI: 10.1007/s40271-020-00441-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Little is known about the benefits, and barriers and facilitators to providing psychosocial support to caregivers to a loved one with a rare disease. OBJECTIVE The aim of our scoping review was to map evidence on (1) perceived benefits and (2) barriers and facilitators of establishing and maintaining services. METHODS The CINAHL and PubMed databases were searched in December 2018. Qualitative and quantitative studies in any language that described perceived or tested benefits of participating in psychosocial interventions for caregivers, or the barriers and facilitators of providing these interventions, were eligible. RESULTS Thirty-four studies were included. Interventions were behavioural or psychological, supportive, educational, or multicomponent. All included studies reported on the benefits of participating in psychosocial interventions; 14 (41%) studies also reported on facilitators and 19 (56%) reported on barriers. Benefits that were most commonly found included statistically significant improvements in emotional states (e.g. stress) and caregiver burden and narrative reports of intervention helpfulness. Statistically significant improvements in mental health outcomes (e.g. depression symptoms) were rarely detected. Four themes for facilitators were identified, including intervention characteristics, intervention delivery characteristics, provision of necessary resources, and support provided outside of the intervention. Four barrier themes were also identified: misalignment of intervention to caregiver needs, inability to make time for intervention, practical barriers, emotional barriers. CONCLUSIONS Psychosocial interventions for caregivers to a loved one with a rare disease may be helpful in reducing stress, burden, and feelings of isolation among caregivers. Future research should design interventions for caregivers that take into account facilitators and barriers to establishing and maintaining such interventions.
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Kearney S, Donohoe A, McAuliffe E. Living with epidermolysis bullosa: Daily challenges and health-care needs. Health Expect 2019; 23:368-376. [PMID: 31868299 PMCID: PMC7104643 DOI: 10.1111/hex.13006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 11/12/2019] [Accepted: 11/12/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND & OBJECTIVE Epidermolysis bullosa (EB) is the term used for a group of genetic skin fragility disorders. For those living with EB, pain represents a constant challenge, with blistering and tasks such as changing dressings, adding to the distress. This paper focuses on describing and exploring the health-care needs of children, adults and families who are affected by EB. The specific aim of the paper is to identify the needs of the EB population with a view towards informing the development of a community liaison service to support adults living with EB and the parents/carers of children living with EB. SETTING AND PARTICIPANTS Interviews with six adults and the parents of eight children with EB were conducted. The data were analysed thematically. All participants were resident on the island of Ireland and are therefore reflecting on services in this geographic region. RESULTS Participants' needs were grouped into five themes: support managing physical health-care issues; access to community/home-based services; EB-specific information and psychosocial support; effective interaction with health-care professionals; and advice regarding benefits and entitlements. DISCUSSION AND CONCLUSIONS This article represents the health-care needs and preferences of a broad spectrum of those with EB, highlighting the need for a comprehensive service regardless of the severity of the condition.
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Affiliation(s)
- Sandra Kearney
- IRIS Centre, School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - Ann Donohoe
- School of Nursing and Midwifery, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Eilish McAuliffe
- IRIS Centre, School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
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Khan MT, O'Sullivan M, Faitli B, Mellerio JE, Fawkes R, Wood M, Hubbard LD, Harris AG, Iacobaccio L, Vlahovic T, James L, Brains L, Fitzpatrick M, Mayre-Chilton K. Foot care in epidermolysis bullosa: evidence-based guideline. Br J Dermatol 2019; 182:593-604. [PMID: 31397882 PMCID: PMC7065089 DOI: 10.1111/bjd.18381] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2018] [Indexed: 11/28/2022]
Abstract
This guideline was designed to provide service providers and users with an evidence-based set of current best practice guidelines for people and their families and carers, living with epidermolysis bullosa (EB). A systematic literature review relating to the podiatric care of patients with EB was undertaken. Search terms were used, for which the most recent articles relating to podiatric treatment were identified from as early as 1979 to the present day, across seven electronic search engines: MEDLINE, Wiley Online Library, Google Scholar, Athens, ResearchGate, Net and PubFacts.com. The Scottish Intercollegiate Guidelines Network (SIGN) methodology was used. The first guideline draft was analysed and discussed by clinical experts, methodologists and patients and their representatives at four panel meetings. The resulting document went through an external review process by a panel of experts, other healthcare professionals, patient representatives and lay reviewers. The final document will be piloted in three different centres in the U.K. and Australia. Following an EB community international survey the outcomes indicated six main areas that the community indicated as a priority to foot management. These include blistering and wound management, exploring the most suitable footwear and hosiery for EB, management of dystrophic nails, hyperkeratosis (callus), maintaining mobility and fusion of toes (pseudosyndactyly). The evidence here is limited but several interventions currently practised by podiatrists show positive outcomes.
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Affiliation(s)
- M T Khan
- EB Department, Great Ormond Street Hospital for Sick Children, London, U.K.,Royal London Hospital for Integrated Medicine, UCLH, London, U.K.,St George Hospital, Sydney, NSW, Australia.,Barts and The London NHS Foundation Trust, London, U.K
| | - M O'Sullivan
- University Hospitals Birmingham NHS Trust, Solihull Hospital, Solihull, U.K.,Birmingham Women's and Children's NHS Foundation Trust, Podiatry Birmingham, Birmingham, U.K
| | - B Faitli
- EB Department, Great Ormond Street Hospital for Sick Children, London, U.K
| | - J E Mellerio
- EB Department, Great Ormond Street Hospital for Sick Children, London, U.K.,St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, U.K.,St John's Institute of Dermatology, Rare Diseases Centre, London, U.K
| | - R Fawkes
- St John's Institute of Dermatology, Rare Diseases Centre, London, U.K
| | - M Wood
- EB Department, Great Ormond Street Hospital for Sick Children, London, U.K
| | - L D Hubbard
- St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, U.K
| | - A G Harris
- St George Hospital, Sydney, NSW, Australia.,Department of Dermatology, Concord Hospital, Sydney, NSW, Australia
| | - L Iacobaccio
- The Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - T Vlahovic
- Temple University, Philadelphia, PA, U.S.A
| | - L James
- University Hospitals Birmingham NHS Trust, Solihull Hospital, Solihull, U.K.,Birmingham Women's and Children's NHS Foundation Trust, Podiatry Birmingham, Birmingham, U.K
| | - L Brains
- DEBRA Australia Member and Volunteer, Pittsworth, QLD, Australia
| | - M Fitzpatrick
- DEBRA Australia Member and Volunteer, Pittsworth, QLD, Australia.,DEBRA International, Vienna, Austria
| | - K Mayre-Chilton
- St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, U.K.,DEBRA International, Vienna, Austria
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Martin K, Geuens S, Asche JK, Bodan R, Browne F, Downe A, García García N, Jaega G, Kennedy B, Mauritz PJ, Pérez F, Soon K, Zmazek V, Mayre-Chilton KM. Psychosocial recommendations for the care of children and adults with epidermolysis bullosa and their family: evidence based guidelines. Orphanet J Rare Dis 2019; 14:133. [PMID: 31186066 PMCID: PMC6560722 DOI: 10.1186/s13023-019-1086-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 05/01/2019] [Indexed: 12/13/2022] Open
Abstract
Epidermolysis Bullosa (EB) is a group of rare genetic disorders resulting in skin fragility and other symptoms. Commissioned by DEBRA International and funded by DEBRA Norway, this evidence-bases guideline provides recommendations to optimise psychosocial wellbeing in EB.An international multidisciplinary panel of social and health care professionals (HCP) and people living with EB was formed. A systematic international literature review was conducted by the panel following the Scottish Intercollegiate Guidelines Network (SIGN) methodology. The resulting papers underwent systematic selection and critique processes. Included papers were allocated to 6 different outcome groups to allow data synthesis and exploration: quality of life, coping, family, wellbeing, access to HCP and pain. Based on the evidence in those papers, recommendations were made for individuals living with EB, family and caregivers and HCP working in the field.Few studies have investigated interventions and which factors lead to better outcomes, but general recommendations can be made. EB is a complex disease impacting enormously on every aspect of psychosocial life. People and families living with EB need access to multidisciplinary support, including psychological guidance, in order to improve quality of life and psychosocial wellbeing. Interventions should stimulate social participation to prevent isolation. People with EB and their families should be able to access a supportive network. HCP should be well supported and educated about the complexity of EB. They should work collaboratively with those around the individual with EB (e.g. schools, employers etc.) to provide psychosocial opportunity and care.Attention should be paid to the psychosocial impact of EB as well as physical needs. Directions for research are indicated.
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Affiliation(s)
- K. Martin
- University Hospitals Birmingham NHS Trust, Solihull Hospital, Solihull, B91 2JL, UK
| | - S. Geuens
- Universital Hospitals Leuven, Leuven, Belgium
| | - J. K. Asche
- DEBRA Norge and person living with JEB, Stavanger, Norway
| | - R. Bodan
- California State University, Fullerton, CA USA
| | - F. Browne
- Our Lady’s Children’s Hospital Crumlin, Dublin, Ireland
| | - A. Downe
- Guy’s and St Thomas’ Hospitals NHS Foundation Trust, London, UK
| | | | - G. Jaega
- Psychology graduate and person living with EBS, Liverpool, UK
| | - B. Kennedy
- Our Lady’s Children’s Hospital Crumlin, Dublin, Ireland
| | - P. J. Mauritz
- The University Medical Center Groningen, Groningen, the Netherlands
| | | | - K. Soon
- Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | | | - K. M. Mayre-Chilton
- Guy’s and St Thomas’ Hospitals NHS Foundation Trust, London, UK
- DEBRA International, Vienna, Austria
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Gowran RJ, Goldberg M, Comanescu G, Ungureanu C, Garcia FDS, Xavier CA, Pearlman J. Developing country-specific wheelchair service provision strategic plans for Romania and the Philippines. Disabil Rehabil Assist Technol 2019; 14:612-627. [PMID: 30822183 DOI: 10.1080/17483107.2018.1539131] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Background: Achieving appropriate wheelchair provision at a national level is complex, requiring regulations, funding and policies established through governments. Understanding wheelchair provision within different countries is key. This paper describes the process used to support the development of wheelchair service strategic plans in Romania and the Philippines. It considers the influences, meaning, challenges and developments when producing strategic priorities within two different contexts. Methods: The International Society of Wheelchair Professionals (ISWP) sponsored affiliates Motivation Foundation Romania and the Philippine Society of Wheelchair Philippine Society of Wheelchair Professionals (PSWP), to conduct organizational ethnographic mixed method stakeholder centred studies, to develop robust strategic plans. An affiliate coordinator for wheelchair provision in less resourced settings supported this process. Results: Diversity between the two-affiliate sites was evident, influencing value placed within both societies towards equality and participation. Common components to address included: advocacy; wheelchair service infrastructure; capacity building; education; training and research. Research process facilitation supported by affiliate coordinator is important. Conclusion: Understanding contextual dimensions, which sharp a countries wheelchair service, is essential. Member states should take action by conducting in-country wheelchair sector analysis, to create wheelchair provision strategies for sustainable development, to meet personal posture and mobility needs, primary for daily living, as a basic human right. Implications for rehabilitation Understanding the complexity of providing appropriate wheelchairs within different countries is essential to meet the diverse needs of citizens. Conducting situational analysis of the wheelchair sector involving key stakeholders in the process is important to understand different perspectives and develop strategic priorities towards sustainable development. Producing context specific wheelchair sector reports and strategic plans strengthens the evidence base when informing governments regarding the importance of developing sustainable wheelchair provision infrastructures. The affiliate coordinator role is important to support affiliates to produce robust documentation that clearly and objectively outlines the wheelchair sector issues and plans, to provide solutions.
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Affiliation(s)
- Rosemary Joan Gowran
- a School of Allied Health, Faculty of Education and Health Sciences, Health Research Institute, University of Limerick , Limerick , Ireland.,b Occupational Therapy, School of Health and Sport Science, University of Sunshine Coast , Queensland , Australia
| | - Mary Goldberg
- c Department of Rehabilitation Science & Technology , University of Pittsburgh , Pittsburgh , PA , USA
| | | | | | | | - Cheryl Ann Xavier
- e Philippine Society of Wheelchair Professionals, Inc , Manila , Philippines
| | - Jon Pearlman
- c Department of Rehabilitation Science & Technology , University of Pittsburgh , Pittsburgh , PA , USA
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Nanda A, Liu L, Al-Ajmi H, Al-Saleh QA, Al-Fadhli S, Anim JT, Ozoemena L, Mellerio JE, McGrath JA. Clinical subtypes and molecular basis of epidermolysis bullosa in Kuwait. Int J Dermatol 2018; 57:1058-1067. [PMID: 30011071 DOI: 10.1111/ijd.14099] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Revised: 03/15/2018] [Accepted: 06/04/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Epidermolysis bullosa (EB) is a clinically and genetically heterogeneous blistering skin disease, but in countries such as Kuwait, there are very limited data on the clinical and molecular pathology of EB. To improve understanding of EB in Kuwait, we report the experience of a local tertiary referral center over a 17.5 year period (January 2000-June 2017) in establishing clinical and molecular diagnoses. METHODS Review of hospital records and diagnostic reports. Individual cases were diagnosed by combinations of clinical assessment, skin biopsy (immunohistochemistry and transmission electron microscopy), Sanger sequencing of EB genes, and whole exome sequencing. RESULTS Fifty-four families with EB were registered with the clinic over this period, 41 of whom (84 patients) participated in diagnostic studies. Thirty-seven of these 41 families had consanguineous marriages; 34 had recessive forms of EB, while only seven had dominant subtypes. Recurrent mutations were observed in epidermal dystonin, transglutaminase 5, and type VII collagen. CONCLUSIONS The prevalence of EB in Kuwait is approximately three times that of internationally cited rates with an over-representation of autosomal recessive variants. Establishing the molecular basis of EB in Kuwait with accurate diagnostic subtyping provides a basis for determining healthcare requirements and improving patient management of EB.
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Affiliation(s)
- Arti Nanda
- As'ad Al-Hamad Dermatology Center, Salmiya, Kuwait
| | - Lu Liu
- National Diagnostic Epidermolysis Bullosa Laboratory, Viapath, St. Thomas' Hospital, London, UK
| | | | | | - Suad Al-Fadhli
- Department of Medical Laboratory Sciences, Faculty of Allied Health Sciences, Kuwait University, Safat, Kuwait
| | - John T Anim
- Department of Pathology, Faculty of Medicine, Kuwait University, Safat, Kuwait
- Ghana College of Physicians and Surgeons, Accra, Ghana
| | - Linda Ozoemena
- National Diagnostic Epidermolysis Bullosa Laboratory, Viapath, St. Thomas' Hospital, London, UK
| | - Jemima E Mellerio
- St. John's Institute of Dermatology, King's College London, Guy's Campus, London, UK
| | - John A McGrath
- St. John's Institute of Dermatology, King's College London, Guy's Campus, London, UK
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Cañedo-Ayala M, Rice DB, Levis B, Carrier ME, Cumin J, Malcarne VL, Hagedoorn M, Thombs BD. Factors associated with symptoms of depression among informal caregivers of people with systemic sclerosis: a cross-sectional study. Disabil Rehabil 2018; 42:394-399. [DOI: 10.1080/09638288.2018.1500647] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Mara Cañedo-Ayala
- Lady Davis Institute of the Jewish General Hospital, Montreal, Canada
| | - Danielle B. Rice
- Lady Davis Institute of the Jewish General Hospital, Montreal, Canada
- Department of Psychology, McGill University, Montreal, Canada
| | - Brooke Levis
- Lady Davis Institute of the Jewish General Hospital, Montreal, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada
| | - Marie-Eve Carrier
- Lady Davis Institute of the Jewish General Hospital, Montreal, Canada
| | - Julie Cumin
- Lady Davis Institute of the Jewish General Hospital, Montreal, Canada
| | - Vanessa L. Malcarne
- Department of Psychology, San Diego State University, San Diego, CA, USA
- Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, San Diego, CA, USA
| | - Mariët Hagedoorn
- University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Brett D. Thombs
- Lady Davis Institute of the Jewish General Hospital, Montreal, Canada
- Department of Psychology, McGill University, Montreal, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada
- Department of Psychiatry, McGill University, Montreal, Canada
- Department of Medicine, McGill University, Montreal, Canada
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MacLachlan M, Banes D, Bell D, Borg J, Donnelly B, Fembek M, Ghosh R, Gowran RJ, Hannay E, Hiscock D, Hoogerwerf EJ, Howe T, Kohler F, Layton N, Long S, Mannan H, Mji G, Odera Ongolo T, Perry K, Pettersson C, Power J, Delgado Ramos V, Slepičková L, Smith EM, Tay-Teo K, Geiser P, Hooks H. Assistive technology policy: a position paper from the first global research, innovation, and education on assistive technology (GREAT) summit. Disabil Rehabil Assist Technol 2018; 13:454-466. [PMID: 29790393 DOI: 10.1080/17483107.2018.1468496] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
Increased awareness, interest and use of assistive technology (AT) presents substantial opportunities for many citizens to become, or continue being, meaningful participants in society. However, there is a significant shortfall between the need for and provision of AT, and this is patterned by a range of social, demographic and structural factors. To seize the opportunity that assistive technology offers, regional, national and sub-national assistive technology policies are urgently required. This paper was developed for and through discussion at the Global Research, Innovation and Education on Assistive Technology (GREAT) Summit; organized under the auspices of the World Health Organization's Global Collaboration on Assistive Technology (GATE) program. It outlines some of the key principles that AT polices should address and recognizes that AT policy should be tailored to the realities of the contexts and resources available. AT policy should be developed as a part of the evolution of related policy across a number of different sectors and should have clear and direct links to AT as mediators and moderators for achieving the Sustainable Development Goals. The consultation process, development and implementation of policy should be fully inclusive of AT users, and their representative organizations, be across the lifespan, and imbued with a strong systems-thinking ethos. Six barriers are identified which funnel and diminish access to AT and are addressed systematically within this paper. We illustrate an example of good practice through a case study of AT services in Norway, and we note the challenges experienced in less well-resourced settings. A number of economic factors relating to AT and economic arguments for promoting AT use are also discussed. To address policy-development the importance of active citizenship and advocacy, the need to find mechanisms to scale up good community practices to a higher level, and the importance of political engagement for the policy process, are highlighted. Policy should be evidence-informed and allowed for evidence-making; however, it is important to account for other factors within the given context in order for policy to be practical, authentic and actionable. Implications for Rehabilitation The development of policy in the area of asssitive technology is important to provide an overarching vision and outline resourcing priorities. This paper identifies some of the key themes that should be addressed when developing or revising assistive technology policy. Each country should establish a National Assistive Technology policy and develop a theory of change for its implementation.
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Affiliation(s)
- Malcolm MacLachlan
- a Assisting Living & Learning (ALL) Institute, Maynooth University , Maynooth , Ireland.,b Centre for Rehabilitation Studies , Stellenbosch University , Tygerburg , South Africa.,c Olomouc University Social Health Institute, Palacky University Olomouc , Olomouc , Czech Republic
| | | | - Diane Bell
- e Centre for Rehabilitation Studies, Stellenbosch University , Cape Town , South Africa
| | | | | | | | | | - Rosemary Joan Gowran
- j Department of Clinical Therapies, Faculty of Education and Health Sciences , University of Limerick , Limerick , Ireland
| | | | | | | | - Tracey Howe
- n Glasgow Caledonian University , Glasgow , UK
| | - Friedbert Kohler
- o Hammond Care Braeside Hospital, University of New South Wales , Sydney , Australia
| | - Natasha Layton
- p Department of Health Professions, Swinburne University of Technology , Hawthorn , Australia
| | - Siobhán Long
- q Assistive Technology and SeatTech Services , Enable Ireland , Dublin , Ireland
| | - Hasheem Mannan
- r Health Systems Research Group , University College Dublin , Dublin , Ireland
| | - Gubela Mji
- b Centre for Rehabilitation Studies , Stellenbosch University , Tygerburg , South Africa
| | | | - Katherine Perry
- t Independent Consultant & Policy Advocate , Brussels , Belgium
| | - Cecilia Pettersson
- u Department of Architecture and Civil Engineering , Chalmers University of Technology , Goteborg , Sweden
| | - Jessica Power
- v Centre for Global Health , Trinity College Dublin , Dublin , Ireland
| | | | - Lenka Slepičková
- x Olomouc University Social Health Institute, Palacky University Olomouc , Olomouc , Czech Republic
| | - Emma M Smith
- y Graduate School, University of British Columbia , Vancouver , British Columbia , Canada
| | - Kiu Tay-Teo
- z Melbourne School of Population and Global Health , Melbourne University , Melbourne , Australia
| | | | - Hilary Hooks
- a Assisting Living & Learning (ALL) Institute, Maynooth University , Maynooth , Ireland
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MacLachlan M, Scherer MJ. Systems thinking for assistive technology: a commentary on the GREAT summit. Disabil Rehabil Assist Technol 2018; 13:492-496. [PMID: 29772950 DOI: 10.1080/17483107.2018.1472306] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
The area of assistive technology has a long history of technological ingenuity and innovation. In order to ensure that the benefits of assistive technology are equitably distributed across the population and life course, it is necessary to adopt a systemic approach to the area. We describe examples of systems thinking and non-systems thinking across 10 Ps. These Ps are People (or users, as the primary beneficiaries of assistive technology), Policy, Products, Personnel, Provision (as key strategic drivers at systems level); and Procurement, Place, Pace, Promotion and Partnership (as key situational factors for systems). Together these Ps should constitute a framework for an "open" system that can evolve and adapt, that empowers users, inter-connects key components and locates these in the reality of differing contexts. The adoption of a stronger systems thinking perspective within the assistive technology field should allow for more equitable, more resilient and more sustainable assistive technology across high, middle- and low-income contexts and countries. Implications for Rehabilitation The progress of assistive technology provison has been hampered by disconnected initiatives and activities and this needs to be corrected. Systems thinking is a way of thinking about the connections between things and how these are influenced by contextual and other factors. By encouraging the providers and users of assitive technology to think more systemically we can provide a more cohesive and resilient systems. The user experience is the central component of systems thinking in assistive technologies.
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Affiliation(s)
- Malcolm MacLachlan
- a Assisting Living & Learning (ALL) Institute, Maynooth University , Maynooth , Ireland.,b Centre for Rehabilitation Studies , Stellenbosch University , Tygerberg , South Africa.,c Olomouc University Social Health Institute, Palacky University Olomouc , Olomouc , Czech Republic
| | - Marcia J Scherer
- d Institute for Matching Person and Technology, Inc. , Webster , NY , USA
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Smith EM, Gowran RJ, Mannan H, Donnelly B, Alvarez L, Bell D, Contepomi S, Ennion Wegner L, Hoogerwerf EJ, Howe T, Jan YK, Kagwiza J, Layton N, Ledgerd R, MacLachlan M, Oggero G, Pettersson C, Pousada T, Scheffler E, Wu S. Enabling appropriate personnel skill-mix for progressive realization of equitable access to assistive technology. Disabil Rehabil Assist Technol 2018; 13:445-453. [PMID: 29772939 DOI: 10.1080/17483107.2018.1470683] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND METHODS This paper reviews the current capacity of personnel in enabling access to assistive technology (AT) as well as the systems and processes within which they work, and was reviewed, discussed, and refined during and following the Global Research, Innovation, and Education in Assistive Technology (GREAT) Summit. FINDINGS Key concepts addressed include a person-centred team approach; sustainability indicators to monitor, measure, and respond to needs for service design and delivery; education, research, and training for competent practice, using the six rehab-workforce challenges framework; and credentialing frameworks. We propose development of a competence framework and associated education and training programs, and development and implementation of a certification framework for AT personnel. CONCLUSIONS There is a resolve to address the challenges faced by People globally to access assistive technology. Context specific needs assessment is required to understand the AT Personnel landscape, to shape and strengthen credentialing frameworks through competencies and certification, acknowledging both general and specific skill mix requirements. Implications for Rehabilitation Personnel in assistive technology (AT) provision should be trained using a person-centred team approach, which emphasizes appropriate skill-mix to address multiple needs within the community. Sustainability indicators should be used which allow personnel to monitor, measure and respond to needs for service design and delivery. A competence framework with associated education and training program, coupled with the development and implementation of a certification framework for AT personnel needs, will promote quality in AT personnel training globally.
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Affiliation(s)
- Emma M Smith
- a Rehabilitation Sciences, GF Strong Rehabilitation Research Program, University of British Columbia , Vancouver , Canada
| | - Rosemary Joan Gowran
- b School of Allied Health, University of Limerick , Limerick , Ireland.,c University of Sunshine Coast , Sunshine Coast , Australia
| | - Hasheem Mannan
- d School of Nursing, Midwifery & Health Systems Health Sciences Centre, University College Dublin , Dublin , Ireland
| | | | - Liliana Alvarez
- f School of Occupational Therapy, Western University , London , Canada
| | - Diane Bell
- g World Health Organization , Geneva , Switzerland
| | - Silvana Contepomi
- h Argentine Assistive Technology Association , Buenos Aires , Argentina
| | - Liezel Ennion Wegner
- i Department of Physiotherapy, University of Western Cape , Cape Town , South Africa
| | | | | | - Yih-Kuen Jan
- l The Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois at Urbana-Champaign , Champaign , IL , USA
| | - Jeanne Kagwiza
- m College of Medicine and Health Sciences, University of Rwanda , Kigali , Rwanda
| | - Natasha Layton
- n Department of Health Professions, Swinburne University , Hawthorn , Australia
| | | | - Malcolm MacLachlan
- p Assisting Living & Learning (ALL) Institute, Maynooth University , Maynooth , Ireland
| | | | - Cecilia Pettersson
- q Department of Architecture and Civil Engineering, Chalmers University of Technology , Goteborg , Sweden
| | - Thais Pousada
- r Faculty of Health Sciences, of A Coruña , A Coruña , Spain
| | - Elsje Scheffler
- s Centre for Rehabilitation Studies, Stellenbosch University , Stellenbosch , South Africa
| | - Sam Wu
- t Geisinger Health System , Danville , CA , USA
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Rice DB, Cañedo-Ayala M, Turner KA, Gumuchian ST, Malcarne VL, Hagedoorn M, Thombs BD. Use of the nominal group technique to identify stakeholder priorities and inform survey development: an example with informal caregivers of people with scleroderma. BMJ Open 2018; 8:e019726. [PMID: 29500214 PMCID: PMC5855214 DOI: 10.1136/bmjopen-2017-019726] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES The nominal group technique (NGT) allows stakeholders to directly generate items for needs assessment surveys. The objective was to demonstrate the use of NGT discussions to develop survey items on (1) challenges experienced by informal caregivers of people living with systemic sclerosis (SSc) and (2) preferences for support services. DESIGN Three NGT groups were conducted. In each group, participants generated lists of challenges and preferred formats for support services. Participants shared items, and a master list was compiled, then reviewed by participants to remove or merge overlapping items. Once a final list of items was generated, participants independently rated challenges on a scale from 1 (not at all important) to 10 (extremely important) and support services on a scale from 1 (not at all likely to use) to 10 (very likely to use). Lists generated in the NGT discussions were subsequently reviewed and integrated into a single list by research team members. SETTING SSc patient conferences held in the USA and Canada. PARTICIPANTS Informal caregivers who previously or currently were providing care for a family member or friend with SSc. RESULTS A total of six men and seven women participated in the NGT discussions. Mean age was 59.8 years (SD=12.6). Participants provided care for a partner (n=8), parent (n=1), child (n=2) or friend (n=2). A list of 61 unique challenges was generated with challenges related to gaps in information, resources and support needs identified most frequently. A list of 18 unique support services was generated; most involved online or in-person delivery of emotional support and educational material about SSc. CONCLUSIONS The NGT was an efficient method for obtaining survey items directly from SSc caregivers on important challenges and preferences for support services.
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Affiliation(s)
- Danielle B Rice
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada
- Department of Psychology, McGill University, Montreal, Quebec, Canada
| | - Mara Cañedo-Ayala
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada
| | - Kimberly A Turner
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada
| | - Stephanie T Gumuchian
- Department of Educational and Counselling Psychology, McGill University, Montreal, Quebec, Canada
| | - Vanessa L Malcarne
- Department of Psychology, San Diego State University, San Diego, California, USA
- San Diego Joint Doctoral Program in Clinical Psychology, San Diego State University and the University of California, San Diego, California, USA
| | - Mariët Hagedoorn
- University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Brett D Thombs
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada
- Department of Psychology, McGill University, Montreal, Quebec, Canada
- Department of Educational and Counselling Psychology, McGill University, Montreal, Quebec, Canada
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
- Department of Medicine, McGill University, Montreal, Quebec, Canada
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Facey K, Hansen HP. The imperative for patient-centred research to develop better quality services in rare diseases. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2016; 8:1-3. [PMID: 25616560 DOI: 10.1007/s40271-015-0113-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Karen Facey
- Evidence Based Health Policy Consultant, Woodlands Lodge, Buchanan Castle Estate, Drymen, G63 0HX, UK,
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